Pediatricians’ vaccine attitudes and practices before and after a major measles outbreak (original) (raw)
Related papers
Risk Analysis, 2018
While it seems intuitive that highly visible vaccine-preventable disease outbreaks should impact perceptions of disease risk and facilitate vaccination, few empirical studies exist to confirm or dispel these beliefs. This study investigates the impact of the 2014-2015 Disneyland measles outbreak on parents' vaccination attitudes and future vaccination intentions. The analysis relies on a pair of public opinion surveys of American parents with at least one child under the age of six (N = 1,000 across each survey). Controlling for basic demographics, we found higher levels of reported confidence in the safety and efficacy of childhood vaccinations in our follow-up data collection. However, this confidence was also accompanied by elevated levels of concern toward childhood vaccines among American parents. We then examined how different subgroups in the population scored on these measures before and after the outbreak. We found that parents with high levels of interest in the topic of vaccines and a child who is not fully upto date with the recommended vaccination schedule reported more supportive attitudes toward vaccines. However, future intentions to follow the recommended vaccination schedule were not positively impacted by the outbreak. Possible explanations for these results and implications for vaccination outreach are discussed.
Exploring The Impact Of The US Measles Outbreak On Parental Awareness Of And Support For Vaccination
Health Affairs, 2016
Despite consensus among health officials that childhood immunizations are a safe and effective means of protecting people from disease, some parents remain hesitant about vaccinating their children. This hesitancy has been linked to a lack of confidence in recommended vaccinations as well as a desire to delay or further space out scheduled vaccinations but also outright refusal of vaccines. Using two national surveys of parents of children ages five and younger, collected immediately prior to and in the weeks following the 2014-15 US measles outbreak, this study examined the awareness of this vaccine-preventable disease outbreak among parents and whether awareness of the outbreak affected their beliefs about childhood vaccination, confidence, and intentions. The study found that while most parents were aware of the outbreak, many were not, and the level of familiarity mattered, particularly on measures of confidence in vaccines and support for mandates requiring childhood vaccination. Increases in vaccine-related concerns were found as well, indicating that disease outbreaks foster not just awareness of vaccines and their potential to prevent disease but a range of parental responses. A 2014-15 measles outbreak in the United States, in which 129 people from seven states were reported to have measles linked to the Disneyland theme park in California, provided a tangible reminder of the importance of vaccines and public health immunization recommendations. 1 The majority of those infected either had not been vaccinated or had been incompletely vaccinated. 1,2 While the most recent estimates from the Centers for Disease Control and Prevention show that measles vaccination rates are high for children ages 19-35 months, 3 there were 668 confirmed measles cases in the United States in 2014, and 188 in 2015 as of August 21. 4 A number of studies published in recent years have suggested that vaccine-related hesitancy has caused many, and perhaps a growing number of, parents to delay or decline recommended childhood vaccinations, seek exemptions from state-mandated vaccinations, or request an alternative immunization schedule. 5-9 Given that high vaccination rates are essential to preventing outbreaks of vaccine-preventable diseases and protecting those who are not vaccinated for medical, religious, or philosophical reasons, there has been much interest in specifying the relationship between vaccination rates and cases of vaccine-preventable diseases; 2,7,10-13 parents' vaccination-related beliefs and concerns; 14-16 and identifying factors that affect confidence in, and thus acceptance of, childhood immunization recommendations. 17-19 Studies involving vaccination rates, school exemption policies and rates, and disease cases and outbreaks,
Vaccine, 2021
Background: The measles outbreak that began in December 2014 at the California Disneyland theme park in the United States (U.S.) received a high amount of media attention. Media attention can influence health-related behaviors. We investigated the effect of the Disneyland outbreak on measles-containing vaccine (MCV) uptake among U.S. children. Methods: We used 2012-2017 National Immunization Survey-Child (NIS-Child) data to examine MCV uptake among U.S. children by 19 months of age. We classified MCV coverage among birth cohorts as exposed based on age at the time of the outbreak. A difference-indifferences design with adjustment for categorical birth cohort was implemented in base models to estimate the exposure effect on the outcomes, !1-dose MCV coverage or age at first MCV dose, with pneumococcal conjugate vaccination as a control. Primary analyses included this model adjusted for geographic region, maternal education, race/ethnicity, household income, and insurance status, and an exposure-interaction term with maternal education. All analyses included sampling weights. Results: The study population represented 34,471,357 children. In base models, the Disneyland outbreak was associated with a 1.0% (95% CI: 0.2%, 1.8%) increase in !1-dose MCV coverage and a 6.6 (95% CI: 4.8, 8.5)-day decrease in MCV administration age. In primary analyses, the outbreak was associated with a 3.9% (95% CI: 3.1%, 4.8%) increase in !1-dose MCV coverage among children of college-educated mothers, and a 3.2% (95% CI: 0.6%, 5.9%) decrease among children of mothers earning less than a high school degree. Decreases in MCV administration age ranging from 5.9 (95% CI: 3.3, 8.5) to 9.1 (95% CI: 6.8, 11.4) days were observed across maternal education categories. Conclusions: The Disneyland outbreak was associated with differential effects on MCV coverage by maternal education and decreases in MCV administration age among U.S. children. These findings may provide useful insights to inform methods to address pediatric MCV undervaccination.
Vaccine, 2020
Background: The COVID-19 pandemic and stay-at-home orders have caused an unprecedented decrease in the administration of routinely recommended vaccines. However, the impact of this decrease on overall vaccination coverage in a specific birth cohort is not known. Methods: We projected measles vaccinationcoverage for the cohort of children becoming one year old in 2020 in the United States, for different durations of stay-at-home orders, along with varying catch-up vaccination efforts. Results: A 15% sustained catch-up rate outside stay-at-home orders (compared to what would be expected via natality information) is necessary to achieve projected vaccination coverage similar to previous years. Permanent decreases in vaccine administration could lead to projected vaccination coverage levels below 80%. Conclusion: Modeling measles vaccination coverage under a range of scenarios provides useful information about the potential magnitude and impact of under-immunization. Sustained catch-up efforts are needed to assure that measles vaccination coverage remains high.
The role of epidemiology in informing United States childhood immunization policy and practice
Annals of Epidemiology, 2020
One of the ten greatest public health achievements is childhood vaccination because of its impact on controlling and eliminating vaccine-preventable diseases (VPDs). Evidence-based immunization policies and practices are responsible for this success and are supported by epidemiology that has generated scientific evidence for informing policy and practice. The purpose of this report is to highlight the role of epidemiology in the development of immunization policy and successful intervention in public health practice that has resulted in a measurable public health impact: the control and elimination of VPDs in the United States. Examples in which epidemiology informed immunization policy were collected from a literature review and consultation with experts who have been working in this field for the past 30 years. Epidemiologic examples (e.g., thimerosal-containing vaccines and the alleged association between the measles, mumps, and rubella (MMR) vaccine and autism) are presented to describe challenges that epidemiologists have addressed. Finally, we describe ongoing challenges to the nation's ability to sustain high vaccination coverage, particularly with concerns about vaccine safety and effectiveness, increasing use of religious and philosophical belief exemptions to vaccination, and vaccine hesitancy. Learning from past and current experiences may help epidemiologists anticipate and address current and future challenges to respond to emerging infectious diseases, such as COVID-19, with new vaccines and enhance the public health impact of immunization programs for years to come.
Improving Vaccination Services Delivery – Local contributions to global Measles elimination
European Journal of Public Health, 2018
Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. In order to increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened. Key messages: Mandatory vaccination is generally well accepted and no social determinant can be considered a predictor of acceptability. Confidence in health system is a determinant of acceptance of mandatory vaccination.
Current Opinion in Virology, 2020
The year 2019 marked the return of measles after almost two decades of unprecedented successes in global vaccination programs. Measles transmission due to sharp declines in measles-mumps-rubella (MMR) vaccination coverage is now widespread among nations that previously saw impressive public health gains including Philippines, DR Congo, Madagascar, Samoa, many in Europe, and the United States and Venezuela in the Americas. Key determinants include the interruption of vaccine health systems due to war, conflict, and political instability; food insecurity and urbanization; and an increasingly globalized vaccine hesitancy or antivaccine movement. Vaccine hesitancy is partly responsible for over 100 000 measles cases in Europe in 2019, and the re-emergence of measles to the United States almost twenty years after it was eliminated. Three major elements currently comprise the American antivaccine movement, including a media empire, a political arm, and deliberate predatory behavior. New strategies will be required to counter these activities.